Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | CA | |
Y | 225700000X | Massage Therapist | 4668 | CA |
NPI | 1245653955 |
---|---|
Provider Name | Mr. Gerardo Martinez JR. |
First Address | Palm Desert, CA 92260 |
Second Address | Palm Desert, CA 92260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 06/01/2015 |